As Obamacare implodes, President Trump is trying to get a Republican congress to repeal and replace Obamacare in an orderly fashion with a minimum of disruption to the present healthcare system.

The Republican establishment in congress is trying to disrupt his goal. All the Democrats are going to stonewall him.

Republicans won both houses of congress because they promised to repeal and replace Obamacare. They had seven years to create a plan. They have failed to achieve a consensus in the Republican caucus.

Democrats are starting to talk about making it easy. They are suggesting congress replacing Obamacare with a government run single party payer healthcare system.

You may recall President Obama told John Kerry and Barney Frank that America would get to a single party healthcare system via Obamacare. He told them not to worry.

The reality of the situation is America is inching its way to a universal single party payer healthcare system.

Medicaid, Medicare and the VA system are already single party payer systems. Each one of these programs has been declared unsustainable.

It is incomprehensible to me that the Republican politicians who the American people elected in good faith are not hearing their complaints

Presently 41.5% of the population is in one of these single party payer healthcare plans. 49% of Americans pay no taxes. This means that 51% of Americans are paying the healthcare bill for 49% who do not pay taxes.

This is the redistribution of wealth that Dr. Donald Berwick said was essential in America.

If fact many of the 49% receive additional monies from the government such as food stamps, free mobile telephone service and free housing.

America is on its way to European socialism, This ideological system has failed in Europe.

The following calculation is how I came up with the percentage of Americans that are in an entitlement healthcare system. I use U.S. agency census data.

The chart below displays the total number of individuals enrolled in Medicaid and the Children's Health Insurance Program (CHIP) in the current month (April 2017) and the period prior to the start of first Marketplace open enrollment period or “baseline” period (July – Sept. 2013).

The current enrollment is obviously post Obamacare.

Month

Expansion States

Non-Expansion States

Total

Baseline July-Sept 2013 (Monthly Average) (49 states)

37,069,415

19,733,676

56,803,091

Apr 2017 (preliminary) (51 states)

52,058,495

22,472,507

74,531,002

Medicaid and Chip increased by 22,472,507 since the onset September 2013.

74,531,002/326,613,397 equals 22.81% of the population is on Medicaid so far.

Medicare enrollment is lower than present Medicaid enrollment. As of May 2017, 37,976,052 are on original Medicare and 20,089,220 are on Medicare Advantage or others Medicare plans for a total of 58,065,272 on this single party payer entitlement.

Medicare is an entitlement program with high premiums. The premiums are means tested. People in the upper tax brackets pay over $18,000 a year in after tax dollars premiums for Part B, Part D and Part F.

The people in lower tax brackets pay less. The premium deduction for Part B is taken out of their monthly Social Security check. This creates a burden on their standard of living.

The additional 58,065,272 to the 74,531,002 bring the total percentage of the population on a single payer healthcare system to 40.6%.

(132,596,274/326,613,397= 40.6%)

If the VA healthcare system enrollees are added to the analysis of the number enrollees to a government run single party payer healthcare system the percentages increase.

In Fiscal Year 2014 the total veteran population was 21,619,731. 9,111,955 veterans were enrolled. 6,616,963 veterans used the VA Hospital System. The VA System brings the total number enrollees in a single party payer system to 133,508,229 or 40.9%

“How are patients supposed to be responsible for their healthcare dollars when there is absolutely no transparency and no consistency in pricing.”

The lack of transparency is a major defect in our present healthcare system.

Only 20% of consumers use the healthcare system at any one time. Eighty percent of the consumers have not run into the lack of transparency problem in the healthcare system.

Most consumers do not care about transparency because they have first dollar coverage provided by their employer. They think their medical care is free. They believe they have excellent healthcare insurance.

President Obama took care of that notion with Obamacare. The defective structure of Obamacare caused healthcare insurance premiums and deductibles to skyrocket. First dollar healthcare insurance became too expensive for most employers.

Employers stopped providing first dollar coverage. Middle class employees are now noticing that out of pocket expenses have made their healthcare insurance unaffordable. Consumers have tried to compare prices of competitive providers. They have discovered that it is impossible!

Consumers are becoming aware of the lack of transparency. They have been astonished by this lack of transparency.

There is nothing in the new Republican bill that addresses Republican politicians’ awareness that the lack of transparency is a major defect in the healthcare system.

The lack of transparency is only one of the major defects in our healthcare system.

There is nothing in the Republican bill that speaks to the consumers’ responsibility for their health and healthcare dollars. Consumer driven healthcare is completely ignored.

There is nothing in the bill that addresses effective tort reform. The Massachusetts Medical Society survey showed that defensive testing to avoid lawsuits costs the healthcare system between $250 billion to $700 billion dollars a year.

The lack of the development of systems of care for chronic diseases cost another $700 billion dollars a year that our healthcare system does not address. There is nothing in the bill that emphasizes this very important defect in the healthcare system.

The Republican establishment thinks consumers are too stupid to take care of themselves.

The mainstream media likes to tell us that people love entitlements. The public does not want to give up these entitlements.

My question is how come less than 9 million people signed up for Obamacare’s individual healthcare plans last year if they love entitlements?

It is because they cannot afford to buy the health exchange insurance even though 85% of the premiums of those 9 million consumers are subsided by the government. Their high deductibles are not subsidized.

The Republicans are going claim they are promoting health savings accounts. The public is not told the amount of money they can put into a health savings account or whether it will provide first dollar coverage over that amount if they get sick.

There is no financial incentive for consumers to be responsible for their healthcare or their healthcare dollars.

My Ideal Medical Saving Account is a much better idea.

These are only a few of the major defects in the Republican establishment’s concept to fix the healthcare system.

President Obama did some of the awful things to Obamacare through rules and regulations after certain vested interests complained about the law. Obamacare’s rules and regulations have to be eliminated

There were crony waivers that would make one’s blood boil. In fact, elected congressional members got the best exemptions.

It is becoming apparent that congress doesn’t want to fix the healthcare system for the majority of Americans. The congressional establishment wants to control consumers.

Socialism does not work!

Our political establishment does not tell us about the economic result in other countrys’ single party payer universal healthcare systems.

We don’t have to go to other countries. We only have to go to the indigent areas in California were everyone is covered by Medicaid.

The Republican establishment needs to get off the stick before all of them are kicked out of congress.

Just imagine the healthcare systems savings if every consumer were empowered to shop for the best healthcare at the best price.

The result would be a free market healthcare system in which competition would cleanse the system and make it affordable to everyone.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

The expansions of entitlements has proven to be unaffordable and ineffective in the past.

In the present Republican healthcare bill to repeal and replace Obamacare people who live from paycheck to paycheck will be eligible for a tax credit that is paid to them in advance. This will allow them to have money to pay for their Medical Saving Account.

If the government subsidizes consumers in this way consumers will not only have the money to pay for their medical care they will also have first dollar coverage above the deductible amount provided by the tax credit.

My Ideal Medical Saving Account convert indigent patients from a complete entitlement program (Medicaid) toward a system where patients would be responsible for their care. Patients would try to conserve their healthcare dollars.

If indigent patients save money on their healthcare coverage they will receive the unspent money in a retirement trust account.

Consumers will have the incentive to stay healthy or be treated appropriately and not overuse the healthcare system. This is the way to My Ideal Medical Savings Account can apply to the indigent and consumers of all income levels.

Essential to Medical Savings Accounts are all prices must be transparent. This is where effective software comes in.

The definition of a tax credit in this context is different than applying a tax credit to income earned. If a consumer is eligible to receive a tax credit he receives the money directly from the government to pay for his Medical Saving Account.

The positive effect to the healthcare system is that if the individuals take good care of themselves and are responsible for their health and healthcare and their healthcare dollars they will not end up in the Emergency Room or hospital and spend a lot of their deductible money.

They will have money left from the tax credit given to them by the government. The money is their money and will go directly into a retirement trust fund. The leftover money is not saved to be spent on future healthcare needs.

This financial incentive will keep the cost down for consumers and the healthcare system.

In the Medicaid entitlement program for the indigent and disabled consumers do not have a financial incentive to be responsible for their health and healthcare dollars. With Medical Savings Accounts there is a financial incentive for consumers to be responsible for their health and healthcare dollars.

“The Ideal Electronic Medical Record is essential. YES BUT SOME CAN BE HACKED SO HOW EFFECTIVE WOULD IT BE?”

When going to a Clinic or hospital consumers automatically sign a consent form for the release of medical records. When buying a healthcare insurance policy consumer sign a similar release of medical records form.

Medical records are not as private as we all would like them to be.

It is the Ideal Electronic Medical Record’s software developer who is responsible for developing medical records that cannot be hacked. Americans have been cautioned about computer privacy since 1980. The problem has not been solved yet.

Most of the electronic medical records that are bought by physician offices and hospital systems are from private vendors. The software is expensive and cannot do everything it is supposed to do including protecting the patient’s privacy rights.

The ideal medical record should provide an educational experience to physicians. Presently the software available does not do this.

The EMRs provide a surveillance tool for the government and the insurance companies to judge patient care.

The government should build an un-hackable software system that resides the cloud. Physicians and hospitals should pay for it by the click. It should provide an educational experience for physicians in order to improve patient care. It should not be used as a punitive tool

We have been told over the years that the VA Hospital System has an excellent EMR. Why is the VA Hospital System switching to Cerner’s EMR? Cerner’s EMR has all the defects of commercial EMRs

Cerner’s EMR is not an Ideal Electronic Medical Record. The company probably obtained the government contract because of its political connections.

“Patient education must be an extension of their physicians’ care. ABSOLUTELY BUT IN ENGLISH NOT MED TERMS!”

This is the reason the healthcare system must be consumer driven with community social networking.

If a physician does not satisfy the community he practices in, consumers will know about it quickly through community social networking. They will then have the choice not to use that physician.

If the government, healthcare insurance companies and physicians will not provide the necessary transparency in the system, consumers must.

“A team approach to chronic disease management must be adopted with the patients becoming the professor of their disease.”

AHH But When a patient Tries to Educate themselves on Such---THE INTERNET HONESTLY HAS CONTRADICTING INFO!

I KNOW THIS ONE PERSONALLY AS I HAVE BEEN RESEARCHING FOODS AND INFO ON HIGH CREATININE LEVELS!

MY CREATININE LEVELS ARE HIGHER THAN NORMAL, but there is so much Contradictory Info out there—

-I.E. Should I EAT UNSALTED NUTS OR NOT EAT NUTS> SHOULD I EAT BLAND WHITE BREADS OR THE MORE HEALTHFUL MULTI GRAIN AND WHEAT BREADS!!! And Should I consume Lean Meats and Poultry or NOT! Some say yes, others say No!

Patients’ cannot educate themselves by solely using the Internet. The educational process has to be through their physician and his healthcare team’s selected Internet sites.

The team should pick the Internet resources it wants the patient to use. The appropriately chosen Internet sites should be used as an extension of the physician’s care. Consumers should be confident of the information source picked by their physician and his healthcare team. It will also enhance the physician patient relationship

“Hence on some of the issues you wrote I slightly agree with, but over all you fail to consider the Poorer Americans and that not all Americans have intelligence to research or are too disabled to RESEARCH!”

I believe that everyone should be responsible for his or her medical care and medical education. Ever the poorest people can be responsible for their care and can be educate.

Many social agencies exist to help poor people be responsible for themselves.

Individual responsibility and initiative is the principle that has made America great. If a person is not capable of being responsible for himself, artificial intelligence systems could be developed to help this very small percentage of the population survive and thrive.

Entitlements and dependence on the central government by all is what President Obama wanted. It simply results in more debt and a weaker society.

There are many problems in society. We have to start somewhere with good ideas to invigorate all levels of society.